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Hormone Replacement for Men



The New Male Awareness
Eric Everett, RPh, FIACP
Certified Clinical Nutritionist

It’s time for a male revolution.  An insurrection.  A rebellion to the traditional thoughts, practices and denial of the male welfare.  The world must know and understand what happens when our naturally-circulating testosterone begins to disappear.

It happens gradually and without notice.  Like the sapling you planted ten years ago that is now a tree.  Or the little bit of money you have been saving each month that will now buy a car.  With regard to sex hormones, it’s been said women fall off a cliff and men role down a hill.  Either way, by the age of 80, 60 or even 50, the results are the same.

But why should anyone notice or care?  Denied by the patient and unrecognized by the physician, most men don’t even know it exists.  And in medical terms, there is no disease or condition until it is given a name.  So let’s do it, once and for all.  It shall be called andropause.  It shall be recognized by the medical community and the male patient, and it shall bear the burden of our symptoms of aging:

  1. Weakness
  2. Fatigue
  3. Disturbed sleep
  4. Reduced libido
  5. Osteoporosis (yes, in men)
  6. Heart disease
  7. Atherosclerosis
  8. Irritability
  9. Elevated cholesterol
  10. Increased use of alcohol


  1. Erectile dysfunction
  2. Slow wound healing
  3. Prostate problems
  4. Low sperm counts
  5. Depression, anxiety
  6. Reduced muscle mass
  7. Memory impairment
  8. Impaired blood cell formation
  9. Reduced cognitive function
  10. Dry skin

Certainly the first thing society associates with declining testosterone is diminished sex function.  In fact, it is inappropriate, or at least misleading, to refer to testosterone as a sex hormone.  As indicated by the table, there are many other significant facets of andropause that include heart disease, osteoporosis and mental dysfunction.  It could just as easily be called a heart hormone or an anti-depressant hormone.

Unfortunately, these conditions are treated with the same approach Western medicine uses for almost anything: prescription medications that only affect symptoms of the disease, not the cause itself.  It is time to alleviate these symptoms and conditions with much the same approach we use for women – diet, exercise, nutrition, herbal therapy and natural hormone replacement.

Both men and women produce circulating testosterone during most of our adult lives.  Notable differences include much higher levels in men, and the fact that testosterone is the only sex hormone for men, while women also have estrogens and progesterone.

b_Fr_7_1And while researches have found that total testosterone declines in men about 1% per year after the age of 30, free testosterone, or “active testosterone”, declines by as much as 10% per year.  Thus, by the age of 60, you could be experiencing a serious testosterone deficiency.  As it turns out, the reasons for this are not simple:

  1. Testosterone-producing Leydig cells begin to die off, reducing the amount of total testosterone available.
  2. With aging, there is also a loss of circadian rhythm (24-hour cycle) of testosterone secretion. 
  3. Simultaneously, a protein called sex hormone binding globulin (SHBG) increases with age, binding more testosterone and decreasing the amount available for activity.
  4. An enzyme called aromatase increases as we age.  One of the actions of aromatse is to convert what little bit of testosterone that is now left to estrogen.  It is perhaps this event that is most responsible for the many symptoms of male menopause, and possibly even enlarged prostates and prostate cancer.

The benefits of lifestyle modifications and testosterone replacement are many, and read like the reverse of the symptoms mentioned above.  Beyond the improvements in libido and sexual function (Viagra poorly imitates the role of testosterone here) lie important improvements in heart disease, mental function and osteoporosis.

Multiple reports conclude that natural testosterone reduces cholesterol and triglycerides, reduces blood glucose, decreases visceral fat mass and normalizes blood clotting.  Atherosclerotic disease (hardening of the arteries) is known to increase as free testosterone decreases.

Several studies suggest depression in older men can be linked to decreased levels of testosterone.  Normalized testosterone levels can also positively affect cognitive function, concentration, anxiety and confidence.

And did you know that one in three hip fracture patients is male?  Osteoporosis is not just a female disease, and a hip fracture in a male carries an even higher risk of permanent disability and death.  Testosterone’s role in bone health is undeniable and absolute.

b_Entry HallAnd the role of testosterone in BPH (enlarged prostate) and prostate cancer is a victim of medical mythology.  The fact is, both of these events are almost unheard of in teenagers and men younger than 50, when testosterone is at its highest.  Conversely, why do the risks of BPH and prostate cancer continue to grow as levels of testosterone continue to fall?  Interestingly, studies have actually shown the risk of BPH is higher in the presence of decreased testosterone!  As mentioned earlier, there is also compelling evidence that these diseases are related to the increased conversion of testosterone to estrogen.

As you can see, male menopause is real and deserves our attention and respect.  In this mutiny of tradition, we must take up our arms, or at least our brains, and consider these events as we age.  Awareness must begin with men, and then we must work to enlighten our female counterparts and physicians as well.

In the next article of this two-part series, we will explore the natural options available for addressing male health and the symptoms of andropause. 

The New Male Awareness
Eric Everett, RPh, FIACP
Certified Clinical Nutritionist

A major breakthrough has occurred in medicine that promises significant advances in men’s health.  The miracle lies not in a cure, but in the simple recognition of a condition called andropause. 

As sufferers of PMS, fibromyalgia and chronic fatigue already know, a disease or condition endures only in the mind of the patient until the utility of a name brings acknowledgment by the medical community.  In the past, it has been convenient to consider impotence as a psychological disorder.  But with the word andropause, the male counterpart to menopause, a handle has been exposed for the medical community to learn, examine, diagnose and treat.

In part one of this two-part series, we explored the encompassing symptoms of andropause.  In this issue, we will offer options for dealing with the circuitous symptoms of andropause.  Sounding suspiciously like the aging process, symptoms include reduced muscle mass, osteoporosis, irritability, memory impairment, prostate problems, reduced libido, impotence, depression and heart disease (indeed, there are more testosterone receptors in the heart than any other muscle in the body).

The two-edged sword of andropause, wielded by hormones, is a dwindling supply of testosterone and an increase of an enzyme called aromatase.  Aromatase converts the shrinking supply of testosterone to estrogen, and it is elevated estrogen that has recently been credited with many of the negative symptoms of andropause, including an enlarged prostate, heart disease, stroke and others.  In fact, a 1988 UCLA study found that the most significant hormonal association with impotence was elevated estrogen.

Other rogue players in andropause are obesity and alcohol.  Aromatase activity is higher in fatty tissue than in other areas of the body, further increasing the conversion of testosterone to estrogen.  The problem is, decreased testosterone and increased estrogen tend to increase fatty tissue and decrease lean muscle mass – so the negative cycle continues.  Men are all too familiar with the battle of the bulge that coincides with middle age, just as our testosterone starts to wane.
To make matters worse, the hormonal imbalance can cause depression and anxiety to surface, with men turning to alcohol as a short-term solution.  Unfortunately, alcohol also increases aromatase activity and, again, the problem perpetuates.

A natural approach is always prudent in dealing with any chronic condition, and can even be combined with traditional allopathic medicine. There is no claim of a cure with diet, exercise and nutritional supplements; only a promise that any malady becomes more manageable, and andropause is no different.

A diet rich in fresh fruits, vegetables and complex carbohydrates is a cornerstone of health and healing, with a special emphasis here on the reduction of saturated fats.  As mentioned, it is important to maintain an ideal weight to minimize aromatase activity.  But as the body tries to excrete estrogen through the digestive tract and stools, a high-fat diet causes some of this estrogen to be reabsorbed, contributing to the problem of elevated estrogen.

Nutritional supplements can also help to reduce the conversion of testosterone to estrogen.  Zinc supplementation thankfully interferes with aromatase activity, and it is estimated average zinc intake in the United States is about half of the RDA (which is a minimal, not optimal, allowance).  Vitamin C also inhibits aromatase, and along with vitamin E, increases longevity in men. 

Omega-3 (flaxseed oil) has many balancing benefits for symptoms of andropause, including reduced prostate size and cardiovascular improvements.  It is also considered a significant dietary deficiency and supports many body functions.  However, it is not recommended to focus on a few nutrients at the expense of ignoring others.  A complete nutritional program is best and gives optimal results.

Other noteworthy supplements for men include saw palmetto for prostate enlargement and L-arginine, muira puama and ginkgo biloba for erectile dysfunction.  Ginkgo also helps with circulation and memory.

Once these are addressed, and if symptoms persist, it might be worthwhile to visit your doctor for testosterone and estrogen blood tests.  Many men will be candidates for supplemental testosterone, based partially on blood tests and substantially on symptoms.

Since there is a considerable range for what is considered “normal” testosterone blood levels, it is perhaps more important to judge use, dose and progress on the basis of symptoms.  An effective medical evaluation might include the question, “How are you feeling?”
It is important to note maintaining a “normal” blood level of a 60 year-old man will likely be inadequate to reverse symptoms of andropause.  That is, it would be reasonable to restore levels to an equivalent age range of a 30-year-old.

Different options exist once the decision has been made to raise testosterone levels. One option would be to supplement with dehydroepiandrosterone, better known as DHEA, which is non-prescription.  DHEA is a hormone precursor to testosterone, and also has some testosterone-like activity itself.  For many men experiencing mild symptoms of andropause, supplementing with DHEA can make meaningful improvements.

But if actual testosterone replacement therapy is warranted, several items should be remembered.  First, few people, including medical professionals, understand the difference between natural testosterone (not patentable) and the patentable (and therefore profitable) synthetic versions offered by drug companies.  Medical professionals will all too commonly and incorrectly refer to this entire class of chemicals as “testosterone” when, in fact, there is only one such molecule.

Although these compounds are chemically similar, the complex biochemistry of your body does not understand the game of horseshoes, where being close has value.  The chemical must be absolutely exact for optimal outcomes.

When the patient receives a synthetic version of testosterone, they may see improvement in some symptoms, but adverse and dangerous side effects can occur, including liver disease, worsening of cholesterol profiles and heart disease.  Not only does natural testosterone avoid these adversities, it improves cholesterol profiles and reduces heart disease as well.

Next, we must pay attention to the method of introducing natural testosterone into the body.  Since it is poorly absorbed in the digestive tract from a capsule or tablet, this is not an option.  Injections circumvent this problem, but are inconvenient, painful and produce a roller coaster of blood levels – perfect if you like more mood swings than a playground.

The best option is transdermal or “across the skin” delivery of testosterone.  Creams, gels and patches are effectively used to administer more and more medications.  And a small lozenge called a troche that is slowly dissolved in the mouth is gaining popularity as an efficient method of dosing.
Transdermal dosing, especially in regard to hormones, gives much more natural results than pills or injections, and also avoids certain complications.  It is convenient, painless, and can be dosed twice daily for more even blood levels.

While women have always been more in tune with the role of cause and effect in their health, men seem to have been justifiably stereotyped as “beings largely unaware of their body.”  Perhaps with the turn of the century, andropause may mark this as the millennium of male awareness. 

What is a Troche?

So you and your doctor have decided to replace your decreasing hormones with natural hormones instead of the synthetic alternatives.  Congratulations!  But don’t stop here.  The next puzzle piece is how to get the hormones inside your body where they can exert their beneficial effects. 

And don’t be too quick to swallow the obvious:  a capsule or tablet.  The problem is, many of the benefits of natural HRT will be lost as the hormones go through the process of digestion.

None of your circulating hormones are secreted into your digestive tract as a means of total body distribution.  Glands typically secrete hormones into the local circulation where, eventually, they reach complete systemic circulation.  This is physiologically natural.  Hormone delivery via the digestive tract is not.

When hormones are swallowed, they are exposed to digestive acids and enzymes and metabolism as they are absorbed through the gut wall.  Then, like virtually everything absorbed by the digestive process, they are carried directly to the liver in what is called first-pass metabolism.

As a total day’s amount of hormones reach the liver in a very short period of time, this does several things.  First, it is just plain hard on the liver.  And if other medications are being taken, this adds to the liver’s burden and increases the risk of liver toxicity, injury and gall bladder disease.

Next, the liver does not know that this rapid rise in hormone concentration is short-term.  It operates on the basis that hormone levels are way too high, and begins to make changes to counteract this effect.  The net result is that it affects the way your body has access to the hormones.  It affects the estrogen and progesterone you might be taking, but also affects other circulating hormones and chemicals as well.  This includes thyroid hormone, cortisol and a substance called antithrombin III that helps to protect you from strokes and heart attacks.

These changes can increase your blood pressure and cholesterol, affect your mood, lower your thyroid and cortisol potential and increase your risk for a stroke or heart attack.

At this time, viable options to swallowing your hormones include injections and transdermal (across the skin) delivery.  Injections have their obvious drawbacks.

However, transdermal delivery of medications has gained rapid popularity during the last 10 or 15 years.  Estrogen, testosterone, nitroglycerin and nicotine are just some of the different medications in a patch form that are applied to the skin for absorption.  Creams, suppositories and troches are other forms of transdermal absorption, all of which bypass the digestive system and first-pass metabolism.  This is good.

Creams can be very effective, but because of the extreme variation in skin type (thickness, fat content, water content, etc.), their absorption is erratic and unpredictable.

Suppositories, vaginal and rectal, are very effective and dependable for drug delivery, but lack convenience.

Troches, however, offer the best of all worlds.  A dosage form dating back to the 1800s, troches have regained tremendous popularity for the absorption of medications, especially hormones.  They are effective because the lining of the mouth is thin and rich in blood supply.

Troches are small lozenges that dissolve between the cheek and gum over a period of about 30 minutes.  As it dissolves, the hormones are gradually absorbed into the blood stream, resulting in physiologically natural hormone blood levels.  Also, because these are bio-identical to the hormones your body has produced, they are efficiently recognized, utilized, metabolized and excreted by the body.  Since your own hormones only last about 8 to 12 hours, your natural hormone replacement should be dosed about every 12 hours to give adequate, even blood levels.

Synthetic hormones, however, do not fit receptors exactly and are more difficult for your body to metabolize.  That is why they are usually dosed just once per day.

Because of the tremendous advantages in consistency, effectiveness and the ability to avoid the digestive process, we strongly recommend troches as the primary dosage form for hormone replacement therapy for both men and women.

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